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Gout and the Holiday Diet

By Ed Nguyen, M.D., Attending Physician at 75th St. & 126th St. Medical, Ocean Pines Medical & Doctors Weight Control & Wellness centers, Ocean City, MD.

Gout is a relatively common malady that causes discomforting, occasionally debilitating, joint pain. It predominately affects patients starting in their fourth decade of life, with twice the prevalence in men (approximately 13 out of 1000 men) as in women, who receive some protection from estrogen. As an inflammatory condition, gout usually presents with pain affecting one joint in the body, the classic example being pain and swelling in a big toe.

The etiology of gout is an excessive accumulation in the body of uric acid, a metabolite produced by the breakdown of purines in the liver. Gout may occur when the body produces too much uric acid or is unable to excrete it quickly enough. Excessive uric acid will crystallize out of the bloodstream as urate crystals. The presence of these needle-shaped crystals in the joint space is what causes the pain and inflammation associated with gout.

Gout can be precipitated by a number of factors, such as some medications, but now that the holiday season is under way, one preventable cause of gouty attacks for those who are susceptible is surely dietary indiscretion. While there are effective medicines for treating gout, a sensible diet during the holidays is the best and easiest way to prevent flare-ups in the first place.

Certain foods have been well-documented to cause or to worsen gout. In particular, foods high in purine should be avoided or minimized. These foods include the high-protein organ meats (liver, sweetbreads, kidneys, heart, etc.) and seafood (mussels and other shellfish, sardines, crabs, and anchovies). If you are susceptible to gout, limit the daily intake of animal protein in your diet to six ounces a day. Other foods which are moderate in purine content should be limited to one serving a day. These include whole-grain products (such as breads or cereals), asparagus, cauliflower, lentils, beans, peas, mushrooms, oatmeal, and spinach. Some patients even note that chocolate, always a favorite treat during the holidays, can cause a flare-up of their gout. In contrast, a recent study in the New England Journal of Medicine has suggested that a high intake of low-fat diary products can cut the risk of gout by half.

Alcohol should be limited or avoided entirely, as it tends to increase uric acid production. Beer in particular has a relatively high purine content. Naturally, alcohol is part of the holiday festivities, but at least, some reasonable dietary discretion should be exercised. When drinking alcohol, sip slowly and snack on crackers or fruits to help buffer the alcohol. Try to substitute wine or spirits for beer instead, as both have a lower purine content than does beer.

Alternately, drinking plenty of water is always a good idea. Water helps to flush excessive uric acid from the body, and five glasses of water a day should suffice. Another fine substitute is herbal tea. Furthermore, many patients find cherries, in quantities from ten cherries to a half-pound a day, helpful. So, try some cherry juice, too; it couldn't hurt!

Overall, maintaining a good body weight is the key, as obesity may result in an increased production of uric acid in the body. However, fasting or extreme weight-loss programs may actually increase uric acid production in the body. So again, choosing a well-balanced, sensible diet is the best way to go. If you are predisposed to getting gout, keep an eye on what you eat, and hopefully gout will not arise to subdue your holiday cheer!

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